Provider Demographics
NPI:1457650400
Name:COWAN, MICHAEL WAISTELL
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAISTELL
Last Name:COWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-1150
Mailing Address - Country:US
Mailing Address - Phone:717-249-7697
Mailing Address - Fax:717-960-4523
Practice Address - Street 1:1814 SPRING RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-1150
Practice Address - Country:US
Practice Address - Phone:717-249-7697
Practice Address - Fax:717-960-4523
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist